Walkthrough: Management of Care Q3 – NCLEX-RN®

00:01 The nurse receives a call from a client who's a primigravida at 39 weeks gestation, who state's, "Labor has started." The client reports having moderate lower abdominal pain for three hours with contractions every 10 to 12 minutes.

00:14 The contractions improve when the client sits or lies down.

00:18 And no bloody or clear discharge has been seen.

00:21 Which instruction does the nurse give to the client? Okay, I hear you.

00:25 There's a few of you out there going, "Yes, finally, a labor and delivery question." But most of the rest of us were more to like, "Oh, a labor and delivery question." No worries, we have great content for you here about labor and delivery.

00:41 So if you're unsure of some of that stuff, you can brush up on it.

00:44 We're going to talk through the highlights here on this question.

00:47 So you can answer these in the future.

00:50 Now, look at how many lines that question is.

00:53 This is a relatively long question.

00:55 And it is full of assessment information.

00:58 So you're gonna need to really take your time and keep your focus, because my brain sees all those words and says, "I don't want to do this one." But not a good strategy for NCLEX.

01:09 So let's take a look.

01:10 I got a call. So I'm a nurse from a client.

01:14 Primigravida, it's their first pregnancy.

01:16 They're at 39 weeks, which is pretty close. Right? So we know they're toward the end.

01:21 She states labor has started.

01:24 Okay. So the nurse is going to need a little more information than that, besides labor has started.

01:31 So the client reports.

01:34 Alright, we know that's super important.

01:36 So the client reports having moderate lower abdominal pain for three hours with contractions every 10 to 12 minutes.

01:45 Well, I'm telling you, when I take an exam, I'm thinking, I'm actually using my hands in very discreet gestures to help focus my brain.

01:53 So I'm saying, moderate lower abdominal pain.

01:57 Well, of course, it's lower abdominal pain because she's pregnant.

02:00 Look at that descriptor word though. Moderate.

02:03 Okay, so that tells me it's kind of middle of the road there.

02:07 She's been having it for three hours.

02:09 Is that high, lower, or normal? And then contractions every 10 to 12 minutes.

02:14 Numbers? Is that high, low or normal? Here's where you have to make a call.

02:19 Okay, the contractions improve when the client sits or lies down.

02:24 Okay, that's assessment information.

02:27 Is that normal, if somebody's really in intense labor? Will the contractions improve, when the client sits or lies down? No bloody or clear discharge has been seen. Okay.

02:40 So you have to take from all this assessment information.

02:44 Think back what you've learned in your courses about the childbearing family.

02:49 What is the best and safest thing to do for this patient? They're looking to see if you can use your clinical nursing judgment based on the cues in this question.

03:01 And there are a lot of cues.

03:03 All assessment data is considered a cue.

03:07 So what you need to do to answer this question is, we recognize the cues.

03:11 Now you need to analyze them and develop a hypothesis, right? Figure out what you think is actually going on and what is the next best step? So you've got four answer choices there.

03:23 Pause the video. Work through them.

03:26 Eliminate three, and say why? And end up with your best answer.

03:31 Restart the video. We'll walk through it together.

03:43 Hey, welcome back.

03:44 Okay, number one, let's just start at the top.

03:47 Come to the hospital when contractions are three minutes apart.

03:51 Now, remember, we're looking for which instruction does the nurse give to the client? So, come to the hospital, when contractions are three minutes apart.

04:00 What do you remember about that from your class? Well, as a rule of thumb, the client should head to the hospital when the contractions have been five minutes apart for at least one hour.

04:12 And then they last about a minute each.

04:15 So if you want to remember it's the 5, 1, 1 rule.

04:18 So that's the easiest way to remember this, 5, 1, 1.

04:23 So they're five minutes apart for at least one hour and they last at least one minute.

04:30 If you wait to the contractions are three minutes apart, that means they may be too close together for the patient to get the kind of care that they need.

04:38 So remember, 5, 1, 1.

04:42 Now, pause for just a second and see if you can repeat that to yourself a couple times.

04:46 What do those numbers represent? Okay, I know we give you a lot of time to pause and think through but that is really going to help you understand, how to do this on a test? It's also going to help you study as you go.

05:01 Because we don't want to just crank through questions with you.

05:03 We want you to become a better test taker.

05:05 That's what we're after.

05:07 So, number one. We are eliminating, because we know the 511 rule, right? Five minutes apart for the past hour, and one minute long.

05:19 Okay, number two.

05:21 Try to rest and drink fluids and see if the contractions go away.

05:26 Hmm, that seems kind of odd.

05:27 But, you know, this client might not be experiencing true labor.

05:31 I mean, because in real labor, the pain doesn't get better if you sit or lie down.

05:35 Instead, it gets more intense as time passes.

05:38 So, and usually true, labor pain usually starts in the back and moves to the front of the lower abdomen.

05:45 Remember the location of this patient's pain? Right. The nurse could suggest that the client rest and drink water, which may stop the pain if the client is not really into labor.

05:55 A nurse could also teach the client the true signs of labor.

05:58 They could use this as a teaching moment to kind of help the patient think through where we are.

06:03 So you want to teach them things like the contractions that are regular, get closer together, become stronger, start from the back and cause a bloody show, if they're wiping in their vaginal area.

06:14 That's true labor.

06:16 Now, I know you're saying like, "Wouldn't it be better for them to just come to the hospital? Would not be what you'd want to do?" That would be the safest.

06:24 But remember, an NCLEX exam, they're asking you to use your clinical judgment.

06:30 So this nurse, if this answer is right, this nurse is recognizing this is not true labor for all the reasons I just mentioned.

06:38 So we're going to leave it in for now and see if it's the best answer.

06:42 Number three.

06:43 Walk around the house to speed up the labor process.

06:47 Okay. She told you that she feels better when she's sitting or lying down.

06:51 So that indicates a client is likely not having true labor.

06:55 So walking around the house is not going to speed up the labor process.

06:59 That's not appropriate advice.

07:01 That's not good nursing clinical judgment.

07:04 So you want to make sure that you don't give this type of advice to a patient in this kind of situation.

07:10 In this case, we still think it's a better answer to tell the patient, try to rest, drink fluids, and see if the contractions go away.

07:19 So two is still a better answer than three.

07:22 Number four.

07:23 "Have someone drive you to the hospital now or call the ambulance." Well, that would be my response, because maternal child is not my expertise.

07:31 However, what are the things we talked through? This isn't true labor, right? We know the 5, 1, 1 rule.

07:39 We know the signs that we've seen that really indicate she may likely not be in true labor.

07:44 And number two is actually the correct answer.

07:47 Try to rest, drink fluids, see if the contractions go away.

07:52 Alright, did you survive it? Maybe you thrived in that question. But remember, practicing these questions, especially in areas you may not feel comfortable in is a great way to race up your learning.

08:04 So, make sure you're going through all the rationales when you're practicing on your own quiz bank, ask, why is this answer choice right or wrong? If it's unclear to you, or if it's new information to you, be sure to put it in your notebook.

08:19 Because every time you're reviewing information in that notebook, you're asking yourself, "Hey, why would a nurse need to know this particular amount of information? And how would it keep the patient safe?" So like if I wrote down number one, that's the 5, 1, 1 rule.

08:33 I would know like, oh, yeah, if the contractions are less than five minutes apart, I'm not likely giving the best advice.

08:40 Those types of ways to manipulate your notes.

08:44 And I mean, not in a great way.

08:45 Don't just randomly write things down.

08:48 Make sure you're thinking about, why you're writing it down? And how this information will keep a patient safe.

08:54 Okay, whew. You did a lot of work on that one.

08:57 Good job.

08:58 But we're ready for the next one.